Objective: Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. Design: This was a randomized placebo-controlled, cross-over clinical trial. Participants: Ten women with Addison's disease and 10 age-matched healthy females participated in the study. Measurements: All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. Results: Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P!0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. Conclusions: The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.
Izbornim kampanjama, kao osnovnim političkim aktivnostima poklanja se velika pažnja, posebno u pogledu finansiranja troškova izbornih aktivnosti. Finansiranje izborne kampanje u Republici Srbiji regulisano je Zakonom o finansiranju političkih aktivnosti kojim se definišu i uređuju izvori, obim i ograničenja, evidencija i kontrola finansiranja. Po pravilu, pitanje finansiranja političke kampanje postavlja se po završetku izbornog procesa, a kao najveći problem ističe se nedovoljna transparentnost, odnosno javnost podataka i kontrola finansiranja troškova izborne kampanje.
Rad finansiranje izborne kampanje prevashodno ima za cilj da ukaže na pravnu regulativu kojom se reguliše oblast finansiranja političkih kampanja u Republici Srbiji, a u vezi sa tim, posebnu pažnju zavređuje kontrola troškova izborne kampanje koja je u nadležnosti Angencije za borbu protiv korupcije. Nivo političke kulture i političke odgovornosti u Republici Srbiji ukazuje na pogodne uslove za razvijanje političke korupcije koju je neophodno svesti na najmanju moguću meru. Imajući u vidu navedeno, strog nadzor, precizni i strožiji propisi i veća transparentnost podataka o troškovima izbornih aktivnosti političkih subjekata, mogu doprineti smanjenju mogućnosti za koruptivno delovanje u oblasti politike. Konačno, analizom pravnih dokumenata iz oblasti finansiranja političkih kampanja mogu se dati predlozi i preporuke za unapređenje pravnih odredbi iz ove oblasti.
Predmet istraživanja ovog rada je pristup spoljnoj politici Sjedinjenih Američkih Država kao element izborne strategije Hilari Klinton na predsedničkim izborima u Sjedinjenim Američkim Državama 2016. godine. Identifikacija spoljnopolitičkih tema i njihov tretman u izbornoj kampanji poslužiće da se utvrdi vrednosna orijentacija Hilari Klinton, samo poreklo i koreni njenog pristupa spoljnopolitičkim temama, kao i da se utvrdi veza između vrednosne orijentacije i spoljne politike za kakvu se zalagala. Najpre će biti reči o (spoljnopolitičkim) temama kao faktoru izborne motivacije na osnovu socio-psihološkog modela izbornog ponašanja, izbornoj strategiji i vrednosnoj orijentaciji kao njenoj osnovi i savremenom političkom mitu kao jezgru. U radu su analizirani govori kandidatkinje i tri predsedničke debate. Takođe, izborni program Hilari Klinton korišćen je da dopuni ili pojasni nešto što je u predsedničkim debatama već spomenula. Glavni argument je da pristup Hilari Klinton spoljnoj politici ima duboke korene u američkoj istoriji i tradiciji, da je u dobroj meri oblikovan njenim pređašnjim političkim iskustvom i da se temelji na mitu o američkoj izuzetnosti u duhu Vilsonijanaca.
Pulsatile endogenous cortisol secretion is critical for physiological glucocorticoid gene signaling. Conventional glucocorticoid replacement therapy does not mimic endogenous cortisol pulsing in primary adrenal insufficiency. In an open-labelled, two-week, non randomized cross-over study of five patients with adrenal insufficiency (Addison’s disease in two, bilateral adrenalectomy in one and congenital adrenal hyperplasia in two patients) we compared pulsatile and continuous cortisol pump treatment and conventional oral glucocorticoid therapy with respect to twenty-four hour serum corticosteroid levels and plasma adrenocorticotropic hormone (ACTH). Pulsed pump restored ultradian rhythmicity as demonstrated by five peaks of serum (all patients) and subcutaneous tissue cortisol (four patients). Morning subcutaneous cortisol and cortisone were higher in continuous and pulsed pump treatment than in oral therapy despite nearly similar serum cortisol levels in all treatment arms. ACTH was within the physiological range during pulsed pump treatment in all patients except for slightly elevated levels in the morning hours 04·00-08·00. During oral therapy, ACTH was very high in patients with Addison’s disease and suppressed in patients with congenital adrenal hyperplasia. In conclusions, mimicking endogenous cortisol rhythmicity by ultradian subcutaneous infusion of cortisol is feasible. It was superior to both continuous pump and oral therapy in maintaining normal ACTH levels throughout the 24-hours cycle. Our results demonstrate a low free cortisol bioavailability on thrice daily oral replacement therapy compared to both types of subcutaneous infusion.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.